Since HIV/AIDS first emerged as an epidemic more than 30 years ago, there have been many significant developments, both good and bad. The outlook for people with HIV and AIDS is better than it’s ever been, but the virus is still taking its toll. Here’s a look at where we are now, how far we’ve come — and how far we still have to go.

Good news: People are living longer with HIV than ever before. A study published in the Journal of Acquired Immune Deficiency Syndromes reported that the average life expectancy after an HIV diagnosis increased from 10.5 years in 1996 to 22.5 years in 2005.

“Today, I would say the life span of someone diagnosed with HIV early enough following infection, who receives appropriate HIV treatment, is pretty much the same as the life span of someone who is HIV negative,” says HIV specialist Antonio Urbina, MD, associate medical director at the Center for Comprehensive Care at St. Luke’s Roosevelt Hospital in New York City. “I have an 89-year-old HIV-positive patient who is doing remarkably well.” Dr. Urbina says people are living longer because they are . The medications available today are also more effective.

Bad news: In the past decade, approximately 56,000 Americans have been infected with HIV each year, according to the Centers for Disease Control and Prevention (CDC). The number that has remained stable since the late 1990s. “This is a failure — the number of HIV infections should be decreasing,” Urbina says. How to accomplish this? Target the populations where most of the new HIV infections are occurring. “Most new infections are in men who have sex with men,” Urbina says. “And according to 2009 data, 40 percent of new infections are in people between the ages of 13 and 29, most of which are male and African American. We need to target prevention in these high-risk populations.”

Good news: Very few pregnant women with HIV/AIDS pass on the disease to their unborn children. Without HIV treatment, one in four pregnant women with HIV or AIDS transmits the virus to their babies. But thanks to what Urbina calls a “public health miracle,” this number has fallen to less than 1 to 2 percent in the United States. The CDC reports that in 1992, 885 children developed AIDS; in 2005, that number decreased to 57 children — a 93 percent decline.

“Last year, there were only three children infected by HIV-positive mothers in New York state,” Urbina says. There are a few reasons why. “First, every pregnant woman must now be offered HIV testing,” he says. HIV-positive pregnant women are given HIV treatment with antiretroviral medication that prevents them from passing the virus to their babies. After birth, children born to HIV-positive mothers also take antiretroviral drugs for six weeks as an added precaution.

Bad news: One in five people with HIV is unaware of being infected. “There was recently a case of a woman who visited an emergency department four times with dizziness and visual changes, and she wasn’t offered HIV testing; she later developed CMV retinitis, an AIDS complication,” Urbina says. “To stop cases such as these, we need to incorporate HIV testing into routine primary care, just like cholesterol screening and other standard tests.” He adds that routine HIV screening should be done in emergency departments as well, because the poor and uninsured, who are also those at increased risk for HIV and AIDS, often lack access to primary care.

Good news: Most people with HIV don’t pass on their infections to others. In 2006, 95 percent of people living with HIV did not transmit the virus, an 89 percent decline in transmission since the peak of new HIV infections in the mid-1980s. The main reason: “More people are receiving HIV treatment with antiretroviral drugs,” Urbina says. “One study showed that these drugs decrease chances of HIV transmission by as much as 96 percent.”

Bad news: Despite many treatment and prevention successes to combat the HIV epidemic, people are still dying from AIDS. In 2006, HIV was the third leading cause of death for black men and women 35 to 44 years old and the fourth leading cause of death for Latino men and women of the same age. From the start of the HIV epidemic through 2007, more than 576,000 people in the United States have died from AIDS. “Those dying from AIDS are being diagnosed too late," Urbina says. "There is a point of no return with HIV: If the infection goes untreated for years, you damage your immune system too severely." He adds that people diagnosed too late also often have other issues such as substance abuse or mental illness, so these populations need more healthcare access.

Good news: Children born today with HIV benefit from earlier diagnosis and better HIV treatment. “All children born in the United States are tested for HIV/AIDS and started on HIV treatment immediately if they test positive,” Urbina says. “There are now young girls who were infected at birth who have gotten pregnant and given birth to HIV-negative babies — evidence that it is possible to live a normal, productive life with HIV.”

Bad news: Men having sex with men (MSM) make up only 2 percent of the United States population, but they accounted for 61 percent of all new HIV infections in 2009. Men who have sex with other men “report higher rates of condom use and HIV testing than other groups, but they still have the highest rates of infection,” Urbina says.

“Many gay men are testing in the four- to six-week window of time when there is a lot of virus in their bodily fluids, but the antibodies that cause an HIV test to turn positive haven’t appeared yet," he explains. "They then get a false-negative result on an HIV test and use it as a security blanket." One solution to the problem is a different, more effective type of HIV testing. “We need to do more ‘pooled viral load testing,’ which picks up the HIV virus, not just antibodies,” he says. These tests, which are used by all blood banks and some STD clinics, will turn positive as soon as someone is infected with the HIV virus, before he or she can unknowingly begin spreading the virus.

Overall, Urbina says, effective HIV/AIDS prevention needs to involve a more integrative, holistic approach to sexual education. “We can’t rely solely on the medical community,” he says. Sexual education should begin early in life, starting with parents and schools because "children need to understand sex and risk behavior so they are armed with knowledge about what is and what is not safe with regard to HIV."